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Tuesday, June 11, 2013

Another wife easily found: Jane Seymour

Today we continue this blog's obsession with the Tudor period with a discussion about King Henry VIII's third wife, Jane Seymour.

In January 1536 Henry's second wife, Anne Boelyn, miscarried a son at four months gestation. This followed two other miscarriages of male infants after the birth of a healthy daughter, Elizabeth. This proved to be the final straw for Henry, who placed Anne on trial for witchcraft and had her beheaded soon after on the 19th May 1536.

In between the miscarriage and the beheading, Henry moved his mistress, Jane Seymour, into the palace. The two were formally engaged on the 20th May, 1536, the day after Anne's execution, and married ten days later on the 30th May at Whitehall. However Jane was never crowned as Queen as court remained away from London to avoid an outbreak of plague.

Jane was a member of the powerful Seymour family and served as a lady in waiting to both Catherine of Aragorn and Anne Boelyn. She was reportedly not as highly educated as her predecessors with only rudimentary literacy skills. However her needlework was said to be of a very high standard.

(Jane Seymour. Public domain image sourced from wikipedia)

By early 1537 Jane had done her duty as a royal bride and was pregnant.

Unfortunately this would prove the end of her.

On October 10 1537 at the age of 30, Jane went into labour at Hampton Court, 15 miles west of London. Her waters broke to start with and contractions began soon after. After five hours of labour when Jane was examined by her attending physcian the baby was found to be head down, but the head was high and the cervix thick, long and only barely 1cm dilated. Twenty four hours later little progress had been made, and Jane was perhaps 5cm dilated, although the head had descended slightly. By this time the amniotic fluid had become stained with meconium, a sign that the baby was in distress.

The attending physician reported this situation to the king and reportedly suggested a craniotomy or caeserean might be required. Henry's response? "Save the life of the child, for another wife can easily be found."

This is a fairly horrifying statement, but given Henry's past behaviour towards his wives is not entirely surprising.

As it happens neither caeserean or craniotomy were required and some 31 hours following this interaction, after 55 total hours of labour, Jane gave birth to a live male infant. This babe went onto become Edward VI, ruling England from 1547 to 1553, before his untimely death at 17 years old.

Henry was ecstatic.

But what of Jane?

She died 12 days later.

There speculation by some historians that Edward had been born via caeserean section. Caeserean sections at the time were dangerous procedures, only performed on the moribund mother as a last ditch attempt to save the child. They were universally fatal for the mother and nearly always for the infant. The fact that Jane's death occurred 12 days later is a strike against that. Even in the unlikely event that she survived the procedure itself, continuing to live a further 12 days is almost impossible.

The description of the labour itself gives many clues.

Firstly, the duration of 55 hours points to a dysfunctional labour where Jane's contractions simply weren't strong enough to efficiently dilate the cervix. Secondly, the notation that the baby's head was high perhaps points towards a malpositioned baby. Thirdly Jane's membranes were ruptured for between 55 and 60 hours prior to the birth of Edward.

Dysfunctional labours are not uncommon with women giving birth for the first time. The uterus appears to learn with experience, and second labours are always much more efficient as a result. Dysfunctional labours can be dangerous for both mother and baby. Long labours place stress on the baby and they are more likely to become distressed. This can be seen here clearly with the mention of meconium in the waters. Fortunately Edward survived his birth, although many other infants at the time would not have been as lucky. Long labours also can cause problems for mothers, increasing the risk of infection and post partum haemorrhage.

In this day and age this problem is generally assisted by the use of synthetic oxytocin a medication that mimics the hormone that causes contractions. This increases the strength and regularity of contractions and can often mitigate the problems of a long labour.

If this fails to work, caeserean sections are no longer the dire events they once were and have a place in ensuring a safe birth for mother and baby.

Edward's exact malposition is difficult to guess at. We know he was head down. However the fact that his head was so high at the onset of labour gives some clue. It is possible he was either in a occiput posterior position, lying spine to spine with Jane, which tends to slow labour down, or he was in a deflexed position, possibly face or brow.

All of these positions contribute to dysfunctional labour, particularly in a woman in her first labour as prior to the cervix dilating contractions need to move the baby into an appropriate position to be born. The smallest head diameter and therefore most advantageous position is occiput anterior, where the baby has his neck flexed and is facing the mother's spine.

Again in modern times, oxytocin or caeserean section would be used to facilitate a safe birth.

Thirdly, we know Jane's waters broke prior to the onset of contractions, and were therefore broken for between 55 and 60 hours before birth. This is termed prolonged rupture of membranes. The amniotic sac surrouding the baby is specifically designed to keep infection out. After just 24 hours of broken waters the risk of infection to both mother and baby climbs sharply.

With a 60 hour labour and the unsterile conditions of medicine in the 16th century, Jane never stood a chance.

Finally it is possible that a small amount of placenta, or afterbirth, was retained in Jane's uterus. Over time this would again lead to infection. These days this is dealt with by taking a patient to an operating theatre and removing the placenta under general anaesthetic. This was obviously not an option for Jane.

Given the duration between birth and death the most likely cause seems to be an infection, known as puerpal sepsis, although Jane may first have been weakened by a haemorrhage following birth.

Unfortunately this was not an uncommon situation prior to the advent of modern obstetrics.

Despite this sad outcome, Henry VIII was utterly delighted in the birth of his son, and Jane was in the end the only wife that gave him what he most desired. As a result she is the only one of his wives who is buried beside him in Windsor castle.